Predicting the progression of glaucomatous optic neuropathy. Part 1. Biomarkers

Abstract

Current technologies for glaucoma diagnosis show substantial variability and subjectivity in parameters such as intraocular pressure, perimetry findings, and ophthalmoscopy data, raising questions about the accuracy of these tests. Although optical coherence tomography (OCT) remains an objective standard, new methods are emerging, including OCT angiography, laser speckle flowgraphy, analysis of biomarkers in tear fluid and intraocular fluids, genetic markers, and improved structural and functional parameters that expand the possibilities for early and accurate diagnosis of glaucoma. This review discusses biomarkers such as structural parameters of the retina and optic nerve, as well as electrophysiological, vascular, mitochondrial, and molecular biomarkers. Currently, the availability of classic, generally accepted clinical biomarkers provides a basic level of diagnosis and follow-up in patients with glaucoma. However, new information on the pathophysiology of glaucomatous optic neuropathy, together with continuous technological advances in structural and functional diagnostic methods, necessitates consideration of new glaucoma biomarkers with higher sensitivity and specificity. This is particularly important for early diagnosis and prediction of glaucoma progression.